The University of Kentucky College of Medicine proposes a pilot study to test the feasibility of a school-based program for the prevention and treatment of childhood obesity. The prevalence of childhood obesity has increased dramatically in the United States along with a host of obesity-related diseases. The human and economic costs of this epidemic and related illnesses are enormous and, left unchecked, they threaten to overwhelm the health care system of this country. Unfortunately, there are relatively few studies that both document success in obesity prevention and treatment in children, and identify "best practices" suitable for export to other communities and neighborhoods. Initial data from our earlier pilot program at a local elementary school demonstrated a significant improvement in Body Mass Index (BMI) endpoints after only six months of a universal intervention program consisting of physical activity, nutrition instruction, and behavioral modification. Therefore, we propose to test the overall hypothesis that a coalition of academic and community partners can develop and implement a school-based obesity prevention and treatment program that is effective, affordable, scalable, and sustainable. The study design is a parallel-group randomized controlled trial to compare an obesity prevention and treatment program consisting of tiered interventions of escalating intensity with conventional school programs and curricula. Cross-group contamination is minimized by designating an entire elementary school as the intervention group compared with a control elementary school of similar demographic characteristics and student profiles. Specific aim 1 will evaluate the effectiveness of module 1 (universal prevention) interventions aimed at the entire enrollment of the intervention school. They include daily in-class physical activities and nutritional instruction, elimination of food rewards, and improvements in the school menu. Specific aim 2 will evaluate the efficacy of module 2 (Jumpin'Jaguars program) interventions that are targeted to and tailored for children who are at risk or already overweight/obese (i.e., BMI = 85 percent) and at greatest risk for weight-related illnesses. This module includes individualized strategies to enhance physical activity, nutritional education, behavioral modification, and caregiver involvement and participation. The outcomes for both intervention modules are weight, height, calculated BMI, BMI percentile, weight status category and will be obtained every 6-month for two years. We anticipate that the significant improvement in BMI endpoints in module 1 (universal) interventions seen in our earlier pilot will be maintained and extended after the two years of this study. We expect the trend in improvement in BMI endpoints in module 2 interventions (Jumpin'Jaguars) seen in our 6-month earlier pilot will reach significance with the two-year duration of this study. The coalition of academic and community partners enables the leveraging of personnel and material resources such that our program is affordable, scalable, and sustainable. Programs with these characteristics represent the future for the prevention of childhood obesity in this country. Project Narrative: Since childhood obesity and related illnesses have reached epidemic proportions in the United States, effective programs for the prevention and treatment of obesity in children and adolescents are critical for the future health and well-being of the citizens of this nation. In this research application, the University Of Kentucky College Of Medicine proposes to test the efficacy of a school-based childhood obesity prevention and treatment program that is built on a coalition of academic and community partners. This program has a high likelihood of identifying "best practices" that are both affordable and scalable and, therefore, transferable to other communities across the Commonwealth and nation.